Affiliation:
1. Hospital del Trabajador
2. Clínica Dávila
3. Universidad de Chile
Abstract
Abstract
Background
Using expandable cages through the anterior approach is a well-established method for treating thoracolumbar burst fractures. We aim to identify factors associated with cage subsidence and their impact on clinical outcomes in patients treated with corpectomy via a complementary anterior approach.
Methods
We included adult patients with thoracolumbar burst fractures who were treated using the complementary anterior approach at our institution between 2015 and 2021. Our analysis considered factors related to the fracture, implant, subsidence, and functional outcomes (measured by the SF-36). Hounsfield units were measured using the XERO Viewer System on CT scans, and statistical analysis was conducted using R.v4.1 and Rstudio v2021.09.1 + 372.
Results
thirty-one patients were included. A significant difference was found in subsidence magnitude between the "UH < 110" and "UH > 180" groups (p = 0.0468). Patients who received non-modular cylindrical cages had markedly more subsidence and poorer physical outcomes on the SF-36. If the complementary anterior approach was performed six months after the posterior stabilization, all components of the SF-36 were diminished.
Conclusions
To optimize the management of thoracolumbar burst fractures, it is essential to evaluate bone quality before using an anterior approach. Rectangular base modular cages lead to less subsidence and better health outcomes, while non-modular cylindrical cages may decrease physical function. An anterior approach after six months leads to worst functional results. The results provide valuable insights into the use of expandable cages in addressing burst fractures in the lumbar spine.
Publisher
Research Square Platform LLC
Reference19 articles.
1. Management of thoracolumbar spine fractures;Wood KB;The spine journal: official journal of the North American Spine Society,2014
2. Complications of the mini-open anterolateral approach to the thoracolumbar spine;Baaj AA;J Clin neuroscience: official J Neurosurgical Soc Australasia,2012
3. Shen FH, Marks I, Shaffrey C, Ouellet J, Arlet V, Khedr I, Fayed W, A. A., Farhoud A. (2019). Retroperitoneal Extrapleural Approach for Corpectomy of the First Lumbar Vertebra: Technique and Outcome. Journal of Korean Neurosurgical Society, 62(1), 61–70. https://doi.org/10.3340/jkns.2017.0271.
4. Denis F, Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. (1994). A comprehensive classification of thoracic and lumbar injuries. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 3(4), 184–201. https://doi.org/10.1007/BF02221591.
5. Operative treatment of 733 patients with acute thoracolumbar spinal injuries: comprehensive results from the second, prospective, Internet-based multicenter study of the Spine Study Group of the German Association of Trauma Surgery. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of;Reinhold M;Cerv Spine Res Soc,2010